Provider Demographics
NPI:1124114343
Name:NISAR, MOHAMMED (MDPAFACP)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:NISAR
Suffix:
Gender:M
Credentials:MDPAFACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2122
Mailing Address - Country:US
Mailing Address - Phone:732-548-1833
Mailing Address - Fax:
Practice Address - Street 1:1895 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2122
Practice Address - Country:US
Practice Address - Phone:732-548-1833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA026208174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD98902Medicare UPIN